Completing PCS Form DMA 3051 Change of Status Medical CHANGE OF - - PowerPoint PPT Presentation

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Completing PCS Form DMA 3051 – Change

• f Status Medical

CHANGE OF STATUS MEDICAL

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Completing PCS Form DMA 3051 – Change

• f Status Medical

Thi hing ngs s to r

• remembe

ber: r:

• The Change of Status Medical should be

submitted when there is a change in the beneficiary’s medical condition; and

• Must be completed and submitted by the

beneficiary’s Primary Care Physician or Attending Physician.

Note: “Medical” is defined as any change in a person’s health condition that results in improved or decreased ability to perform their Activities of Daily Living.

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Completing PCS Form DMA 3051 – Change

• f Status Medical

For Medical Change of Status Requests, Complete The Following Sections

• Beneficiary Demographics

Section A

• Beneficiary’s Conditions That Result in Need

for Assistance with ADLs

Section B

• Practitioner Information

Section C

• Change of Status: Medical

Section D

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Completing PCS Form DMA 3051 – Change

• f Status Medical

Change of Status Medical Requests, Section D Required Fields

• Describe in detail the change in medical condition which results

in a need for decreased or increased hours of PCS. For clarification when completing the 3051 form, “Medical” is defined as any change in a person’s health condition.